Simple renal cysts are the most common lesions in the kidney. The incidence of renal cyst increases with age. Generally, it is seen during computed tomography or MRI imaging, which is performed by ultrasonography or other radiological evaluations.
Causing clinical symptoms is usually related to the size of the cyst, the localization of the kidney and its internal structure, as well as the presence of other adjacent organs. For example, a cyst that grows outward on the lower edge of the kidney can cause kidney enlargement and pain by pushing the ureter canal into the bladder outside the kidney without reaching large sizes.
In renal cysts with a clinical symptom and single cysts undergoing ultrasound guidance, a needle is sent to the cyst to dispose of the liquid in the cyst and adhere to the cystic walls to give the fluid (sclerosing) to prevent fluid accumulation. Because it is not enough to discharge the cyst with a needle only. If the cyst is emptied only by the needle, the cyst accumulates again into the cyst within a short period of time, the cyst reaches its old size and resumes giving similar clinical symptoms.
Even if the cyst is emptied with the help of the needle, and the sclerosing substance is given to adhere to the inner wall, fluid accumulation and cyst rebuilding are frequently encountered.
Especially in recurrent cysts or kidneys, cysts with a risky or difficult access to the needle are recommended as laparoscopic cyst decortication. With the laparoscopic technique, the cyst and all the surrounding structures are clearly seen by entering the region with 3 small holes through the kidney. In the presence of this image, the cyst is emptied without damaging the other structures of the kidney and the cyst wall is completely removed. Thus, this process called laparoscopic cyst decortication also prevents the formation of a cyst again.
Although being in cystic structures in computed tomography or MR imaging, there are complicated cysts with a risk of cancer. Images of complicated cysts show irregularities in the cyst. There is thickening of the cyst wall or there are signs of bleeding in the cyst. When such complicated cysts are encountered, further evaluation by laparoscopic exploration should be recommended to the patient. An attempt to open and cure cosmetic and healing problems for a cyst will become a highly traumatic approach when the result is a simple cyst.
In particular, with the aid of a laparoscopic telescope-enlarged image, it is clearly visible in tissues that are at risk of developing cancer within or around the cyst, and in the presence of a suspected condition, the cyst fluid is aspirated in a controlled manner and tissue samples from the suspicious area or cyst wall are sent to examine pathologically.
Renal cysts are classified according to BOSNİAK classification according to simple cyst structure or complicated features. In this categorization, it is decided that the patient will be followed up for annual, 6-month follow-up, or surgical exploration and evaluation during the operation. It is recommended that this evaluation be performed with laparoscopy, which helps with the identification of tissues with less trauma and more effective enlargement, instead of open surgery.
Because it is not used in the treatment of open cysts. If it is concluded that the kidney is a simple renal cyst during the surgical procedure, then open surgery in this case will be a very aggressive and unnecessary treatment. Therefore, laparoscopic approach will provide important advantages in every way. If it is concluded that kidney formation is not a simple cyst, but a cystic kidney cancer, then the tumor itself can be removed by going on the operation and left kidney tissue is left in the patient. If it is not possible to remove the tumor from the kidney due to the structure of the tumor then the kidney can be taken from the patient.